HLA EFFECT IN CHILDREN WITH A SECOND LUNG TRANSPLANT.

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HLA EFFECT IN CHILDREN WITH A SECOND LUNG TRANSPLANT.
D. Phelan , K. Schechtman , S. Sweet , C. Huddleston , E. Mendeloff , M. De la Morena and T. Mohanakumar . Barnes-Jewish Hospital HLA Laboratory ; Departments of Biostatistics ; Pediatrics ; Surgery and St. Louis MO, Washington University School of Medicine, Pathology .

Lung re-transplantation is not commonly performed in pediatric patients. According to UNOS data, only 41 pediatric lung transplant (LT) recipients have undergone a second LT in the United States since 1988. To determine if the presence of anti-HLA-antibody before the first and second LT, and/or a positive crossmatch (XM) with the second donor are responsible for early mortality, a chart review of all pediatric patients undergoing second lung transplantation from 1990 to 2002 at a single center was performed. Microlymphocytotoxicity antibody screens and XM were performed by Three Wash Amos and Antiglobulin-Augmented techniques on all patients. 28 patients (16 females and 12 males) underwent 17 bilateral lung and 11 living related lobar transplants. Cystic fibrosis was the primary diagnosis in 17 (60%). 22/28 (78%), 4/28 (14%) and 2/28 (6%) were diagnosed with bronchiolitis obliterans, primary graft failure and pulmonary fibrosis at the time of the second LT. One, 3, and 5 year patient survival is 44%, 25% and 18% respectively. All primary LT utilized cadaveric donors. Of 13 early patient losses (< one year), 2/13 (15%) had presence of anti-HLA prior to the first LT, 5/13 (38 %) developed anti-HLA before the second LT, and 4/13 (31%) were crossmatch positive prior to the second LT. 3/13 (23%) shared mismatched antigens between the first and second donors, 2/3 shared an HLA-A mismatch and 1/3 an HLA-B. Interestingly, 7/13 early losses received second LT from cadaveric donors. The presence of HLA antibodies or positive antibody XM at the time of first or second LT may be important in early graft survival after lung re-transplantation in children. However, more patients undergoing a second LT need to be analyzed to achieve statistically significant differences.